At a Glance
- The monthly cost of many ACA plans has risen, pushing families toward cheaper, higher-deductible options.
- In 2026, the average annual deductible for a bronze plan is $7,500 for an individual.
- States report that 38% of new enrollees in Rhode Island and over a third in California chose bronze plans for the first time.
Why it matters: More people are opting for plans that may leave them with large out-of-pocket bills when they need care, increasing the risk of delayed treatment and financial hardship.
The decision for Kate Bivona and her husband to switch to a lower-premium plan illustrates a broader trend. Beginning in January, the monthly cost of their Affordable Care Act (ACA) insurance jumped by about $300, making it unaffordable. They moved to a bronze plan, cutting their bill by more than half but leaving them with an $18,000 annual deductible. “We would have to take out a loan,” said Bivona, a 37-year-old musician in Arizona. “We don’t have that kind of money, maybe a couple of thousand dollars in savings.”
Why the Shift to Bronze?
The ACA offers four tiers-bronze, silver, gold, and platinum-each balancing monthly premiums against out-of-pocket costs. Bronze plans have the lowest premiums but the highest deductibles and copays. Historically, healthier adults chose bronze plans for the lower monthly cost, but most people still opted for silver plans because they offered a better mix of affordability and coverage.
The expiration of enhanced premium tax credits at the end of last year pushed premiums higher. With limited subsidies, many enrollees are now prioritizing monthly costs over comprehensive coverage. According to state officials, the shift marks a sharp break from past years.
Plan Options and Costs
| Tier | Typical Monthly Premium | Typical Deductible | Key Features |
|---|---|---|---|
| Bronze | Lowest | Highest | Covers basic ACA benefits, but requires payment of thousands before coverage kicks in |
| Silver | Moderate | Moderate | Balances premiums and deductibles |
| Gold | Higher | Lower | More generous coverage |
| Platinum | Highest | Lowest | Comprehensive coverage |
The average annual deductible for a bronze plan in 2026 is roughly $7,500 for an individual, according to KFF, a nonpartisan health policy research group.
Impact on Individuals
Bivona and her husband fit the profile of young, generally healthy adults who use insurance mainly for medications and occasional doctor visits. For them, the decision was about affordability, not coverage logic. “It makes me so angry,” she said.
Health policy experts warn that a broad move toward bronze plans could lead more people to delay care, skip treatment, or take on debt to pay for medical expenses-even though they technically have health insurance. The consequences could be especially severe for people with chronic conditions who are forced into worse coverage.
“If a person suffers from chronic disease or experiences a health emergency, these high-deductible plans push people into bankruptcy,” said Larry Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University. “Also, with high deductibles, many people will hesitate to go for diagnosis and treatment. These delays can make patients sicker or even cause deaths.”
State Trends
Initial federal open-enrollment data shows Obamacare sign-ups are down more than 800,000 from last year. The federal data hasn’t yet broken down which plans people selected, so state data provides the clearest picture.
In Rhode Island, the move toward bronze plans has been especially pronounced among new enrollees. As of early January, 38% of new enrollees had selected bronze plans for 2026, up from 15% two years earlier, while silver fell from 53% to 35% and gold dropped from 31% to 25%.
“Bronze plan selection is up significantly and silver and gold selection is down significantly for new customers,” wrote Christina Spaight O’Reilly, communications director for Rhode Island’s ACA marketplace, in an email.
In California, more than a third of new ACA enrollees have chosen bronze plans for 2026, up from about 1 in 5 last year, state officials said. Nearly three-quarters of renewing customers who switched plan tiers also moved to bronze coverage.
Officials in Kentucky, Idaho, Massachusetts, New York and Virginia also reported an increase in plan switching, with many enrollees moving to cheaper options. Data for Arizona, where Bivona lives, isn’t yet available because it’s federal.
Potential Consequences
Even without the cash to meet a high deductible, the coverage can still protect people from catastrophic medical bills, such as cancer treatment or serious injuries from a car accident. “The people switching to a bronze plan this year may start to feel like they might as well be uninsured,” Cox said.
KFF’s Cynthia Cox, director of the program on the ACA, explained that the idea of the bronze plan was to appeal to younger, healthier people. “You could get a lower premium, you would potentially have a higher out-of-pocket cost, but only if you had a significant health care expense,” she said.
What It Means for You
If you’re considering your ACA options, weigh the monthly premium against the potential out-of-pocket costs. A lower premium may seem attractive, but a high deductible could leave you with a large bill when you need care. Keep in mind that the enhanced premium tax credits have expired, so the cost of higher-tier plans may be less subsidized than in previous years.
For those with chronic conditions or who anticipate significant medical needs, a silver or higher plan may provide more financial protection. However, for young, healthy adults, a bronze plan may still be the best fit if you can afford the deductible.
In any case, staying insured-even with a high deductible-offers a safety net against catastrophic expenses. The key is to understand the trade-offs and plan accordingly.
Key Takeaways
- The shift toward bronze plans reflects rising premiums and the expiration of enhanced subsidies.
- The average deductible for a bronze plan in 2026 is $7,500 for an individual.
- State data shows a significant increase in new enrollees choosing bronze plans, especially in Rhode Island and California.
- High deductibles can lead to delayed care, debt, or bankruptcy for those with chronic conditions.
- Staying insured, even with a high deductible, protects against catastrophic medical bills.
